Provider Demographics
NPI:1609390202
Name:MOLETTE, TAYAJIA RENIQUIE (BS)
Entity Type:Individual
Prefix:MS
First Name:TAYAJIA
Middle Name:RENIQUIE
Last Name:MOLETTE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SAINT BERNARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1329
Mailing Address - Country:US
Mailing Address - Phone:504-943-1857
Mailing Address - Fax:504-943-1858
Practice Address - Street 1:1836 SAINT BERNARD AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1329
Practice Address - Country:US
Practice Address - Phone:504-943-1857
Practice Address - Fax:504-943-1858
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011638566OtherSTATE DRIVER'S LICENCES